DS-19-1333Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: DS-06-19-1333
PGM
�ry���"�' t, J Permit Type: Driveways/Sidewalks/Slabs
Ir Work Classification: Addition/Alteration
Permit Status: Approved
issue Date: 06/12/2019 1 Expiration: 12/09/2019
Location Address Parcel Number
910 NE 91ST TER, Miami Shores, FL 33138 1132060000020
Contacts
TRACY KNIGHT Owner
910 NE 91 TERR, MIAMI SHORES, FL 331383220
HOME OWNER Contractor
HOME OWNER
Description: REMOVE EXISTING CONCRETE DRIVEWAY AND Valuation: $ 2,500.00 Inspection Requests:
REPLACE WITH NEW CONCRTE WITH FIBER GLASS
Total Sq Feet: 550.00 11
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.80
Concrete/asphalt/pavers, slabs, dways,
$75.00
swalks
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.60
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$3.13
Total:
$178.53
Payments
Date Paid Amt Paid
Total Fees
$178.53
Credit Card
06/12/2019 $178.53
Amount Due:
$0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: Irtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulatiArponstru i nd zoning. Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent Date
June 12, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village vEG
Building Department R �o
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
'(201
FBC j�
Master Permit No. ✓` —1 — 13—:33
Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�j p� /�/� CONTRACTOR DRAWINGS
JOB ADDRESS: 1 10 N L' I ��� 1 i I) G1 M l �7 Ch ono-5 FL 33 13 8'
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:/! - 3,?64 20 Is the Building Historically Designated: Yes NO
Occupancy Type: 5 rd Load: Construction Type: Flood Zone: BFE: FFE:
A756-aai-1-7;�i
OWNER: Name (Fee Simple Titleholder): T1066,4106MaSn / Phone#: 30J - 769 - -7,69
p
Address: I t ig o f q,,) J E r",
City: 1, rl M1 sholPS Stater Zip: 53139'
Tenant/Lessee Name: L - Phone#: ,�Db'L-]fig— iS67
Email:_ kQlgGlt//`/�e ����UTI/(. E
CONTRACTOR: Company Name: i Ibm`� \�y� r Phone#:
Address:
City: State: Zip:
Qualifier Name:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
one#:
Certificate of Competency #:
hone#:
Address: City: T,.�tel4{I►tl�!/, State: Zip:
Value of Work for this Permit: Square/0ic_ar Footage•of WarJc)� 6.50 5,7. 4-
Type of Work: ❑ Addition ❑ Alteration
Description of Work:
AfiVou3nij t
Specify color of color thru tile:
Submittal Fee $ t---)— Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $,
(Revised02/24/2014)
Radon Fee $
❑ New epair/Replaci
V ems
Training/Education Fee $
❑ Demolition
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $ 5-W' O'�)
TOTAL FEE NOW DUE $ I-1� • S3
6%, C_'-3 .
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City I State
Zip
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature V Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
_0 6-�" da of V Y1� 20 (I , by
Tr t � who is personally known to
me or o has produced `il / I I 1r1S as
identi icatio a d o did take an ��������Y pR/ //ok
OTA Y PUB I � � �CI�H2aS,V2•• i
Sig
•*�
Print:
The foregoing instrument was acknowledged before me this
day of
me or who has produced
20 , by
who is personally known to
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
• n�� Print:
Seal: U ',�Vz; ' ,*STAirc V�```• Seal:
as
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: �I (,l.Ir kA1 j Q' DATE: (0
ADDRESS: l0 NC `I 1 �re (, Mi aAl i 5►'lO%Qs
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103( 7). And I have
read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that � ds the owner
must appear in person to complete all applications.
State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption
allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the
construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercial building at a
cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or
lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built
for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make
sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on
your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F_I.C.A and
with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all
applicable laws, ordinances, buildings codes and zoning regulations.
Please read and initial each paragraph.
1, 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder permit under an
exemption from the law. The exemption specifies that 1, as the owner of the property listed, may act as my own contractor with certain
restrictions even though I do not have a license.
Initial
2 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and
is not hiring a licensed contractor to assume responsibility.
Initial
3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential
financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the
contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts.
Initial J a!"�
[
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial
building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built w substantially
irproved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the
construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exempton
Initial_
5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
Initial
fi. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building; or residence. It
is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance.
Initial
7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously
implies that the property owner is providing his or her own labor and materials. 1, as an owner -builder, may be held liable and subjected to
serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's
insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance
coverage for injuries to workers on my property.
Initial- :V:�
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform tale
work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by
me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions uncer the
Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow
these may subject to serious financial risk.
Initial T/1,_
9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable lav s and
requirement that govern owner -builders as well as employers. I also understand that the
Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations.
�KInitial__
10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States
Small Business Administration, and the Florida Department of Revenues, I also understand that I may contact the Florida Construction Industry
Licensing Board at 850,487.1395 or http://www.myfloridalicense.com/dbpr/pro/cilb/index.html
Initial ��
11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and understands that. I am the party
legally and financially responsible for the proposed construction activity at the following address:
1l0 YG ql��i A r��id�
' Initial K
12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on
this disclosure.
Initial
Licensed contractors are regulated by laws designed to protect the public. if you contract with a person who does not have a hcensel, the
Constr4uction Industry licensing Board and Department of Business and professional Regulation may be unable to assist you with anv financial
loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed rontractor or
employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder
permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of
the contractor's workers compensation coverage.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local
permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property
owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued.
Was acknowledged before me this -day of 4Vjw , 20 h
By 11OIC �ni rl�
who was personally known to me or who has
Produced ther 4
ense or
OWNER
as identification : + a ';
gym;
Z 2 � v � bTliif
��j//ZM- STA1i . �����►
Miami shores Village
Building Department
SURVEY AFFIDAVIT
STATE OF (FLORIDA)
COUNTY OF (DADE)
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
The undersigned Affiant, ✓ a does hereby attest that
( roperty owner)
The attached survey, performed by r6td , lQ Lj2ielt Mfg5 f- Ma/1 WC y, I n C
�I d (Name of surveyor's company)
For address: -I 1 G C -1 15b I rrace,00 1 a/Y) ► 6lore S
Performed on Ja/alw6a (date of survey) is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affect final inspections as applicable to this or other permits.
FurthWUVau ht
/icy knrq,
Property Owner Signature Property Owner Print Name
SWORN TO AND SUBSCRIBED before me this V� t" day of 1jino 019.
Affiant is personally known to meproducedI l i . S� as identification.
A
�ppY P!Q/Fji
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Revised on 5/22/2009/ Revised on 6/12/09 * ' • •
C \
LOT 8, BLOCK 2
• ' "' ' "' F.F. ELEV. = 13.38'
.... . . .... .
° °S Z (P.B. 39, PG. 41)
• • • • • • • • • • •
gz
see•••°°•• PORTION OF THE
0.0 S.E. 1/4, N.E. 1/4, S.E. 1/4
OF SECTION 6-53-42
itlln
{l}„ ern;{• 'r.., ii:ry:,{.v
63
z 165.00' (REC & M EAS)
`.;
`%;•:: `»:<><.._ 25.00' - 155.00'x.
h j { t
Y
w 3'-2' C.B.S. WALL
.S. WALL
a.
W
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30.60, .00 9t
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'YF i �%::; ".'..: . .Z �\ I�' li - . Z Qr• 1 N
20.00 V 26.25:.
{s a, b m ADDITION
O'!rY,a*:,\•:..).Y):wr<}:. � - � 'N ti �fo.�.:.,.:�.� � F.F. ELEV. — 13.56 "
Ilk
':,�Y.',v{S • ,, n :';tax• 3 x ICI N
::: :'tti�:,,;;ti'{��Y'••'•`y..• "' �Y;rFa �:i°w:;-:;i•�.,ki''`}�.".'� o: r:;:
{:
i-;•:.; •::::r{/ r ask .;r : y.;.,f{G F'+ . • S ,: fit;3>:#:.'•; x ELEV 12 45'
��_'):;1}})A4•S4:titi:{:ySn!{:�:w':;:��si rr��rh::�y:�i: �:�i),iF"rt't;:iin:::! ;+f :r"".!:y/: n::,aii{<.\y{•:4:•i) t:;.i'.iii:•:�: �/.y -...:
>.;:):::::3t 165.00' _.- REC & MEAS
:;��,ir:'<':=:?'.•{:r?Sr:'r :'.yY'::'Z'.x - ','<::
:::3?'%fir,{.,�<'»:<� `r a. a
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LOT 1 BLOCK 3
GOLDEN GATE PARK ADDITION
(P.B. 6 PG 130)
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dj,CT TO Co -,, � NI F1I ALL FEDERI•
J,,TE AND COL;NiY-Ut L, , a -i ,C'
7
SITE
L•OCAITION
LAff4MLNLP
)WHMOe71
"UINUM LIGHT POLE
;ELLSOUTH MAMLOLE
IELsouTH TELEPHONE Box
3QMGNlURK
;ABLE Box
:ATCH BASIN
:ENTERUNE
,'BEAN OUT VALVE
CHAIN LINK FENCE
CONCRETE
CONCRETE BLOCK STRUCTURE
CONCRETE LIGHT POLE
CONCRETE POWER POIE
CONTROL VALVE
DRAINAGE MANHOLE
DRILL HOLE
DUAL POLE SIGN
ELECTRIC Box
ELECTRIC METER
ELECTRIC WARE OVERHEAD
ELEVATION (EXISTING)
ELEVATION (PROPOSED)
FINISHED FLOOR
FIRE HYDRANT
FIRE MAIN VALVE
TIM" PM " DDR MWAW YAIRM
FORCE MAIN VALVE
GARAGE
GAS MANHOLE
GAS METER
GAS VALVE
GUARD POST
PON FENCE
RON PIPE
LIGHT POLE
LIMITED ACCESS RIGHT OF WAY
MAIN SEWER VALVE
MAIL Box
MANHOLE
MEASURED
MONUMENT
NAIL
NAIL AND OISC
ON UNE
PLAT BOOK
POINT OF CURVATURE
PERMANENT CONTROL POINT
PAGE
PROPERTY LINE
PERMANENT REFERENCE MONUMENT
RAIL ROAD GROSSING SIGN
RECORDED INFORMATION
RIGHT OF WAY
SECTION
SECTION CORNER
SEWER MANHOLE
SIGN
SPRINKLER VALVE
SWARE CUT AND NAIL
STORM MANHOLE
STREET LIGHT Box
STREET SIGN
TELEPHONE BOX
TELEPHONE MANHOLE
TRAFFIC SK NAL
TRAFFIC SIGNAL Box
VALVE
WATER METER
WATER VALVE
Wood FENCE
Wood LIGHT POLE
WOOD POWER POLE
ASPHALT
BRICK
CONCRETE
TILE
LOCATION MAP:
NOT TO SCALE
PORTION OF SECTION 6-53-42
LEGAL DESCRIPTION:
The West 94.00 feet of the West 169.00 feet of the South 165.00 feet
of the South 1 /2 fo the S.E. 1 L4 of the N.E. 1 /5 of the S.E. 1 /4 of
Section 6, Township 53 South, Range 42 East, bode County, Florida; LESS
AND EXCEPT the North Ten feet thereof. Presently in use as a portion of
the Right—of—Woy for 91st Terrace.
SURVEYOR'S NOTES:
1) The herein captioned Property was surveyed and described based
on the shown Legal Description: Provided by Client.
2) This Certification is only for the lands as described. It is
not a certification of Title, Zoning, Easements, or Freedom
of Encumbrances. ABSTRACT NOT REVIEWED.
3) There may be additional Restrictions not shown on this survey
that may be found in the Public Records of Miami —Dade County,
Examination of ABSTRACT OF TITLE will have to be made to
determine recorded instruments, if any affecting this property.
4) Accuracy.
The expected use of the land, as classified in the Minimum
Technical Standards (61G17-6FAC), is "High Risk Residential".
The minimum relative distance accuracy for this type of
boundary survey is 1 foot in 10,000 feet. The accuracy obtained
by measurement and calculation of a closed geometric figure
was found to exceed this requirement.
5) lines ofithe parcelrheorein gdescribed arecnot shown hereoboundary
6) Not valid without the signature and the original raised seal
of a Florida Licensed Surveyor and Mapper. Additions or
deletions to survey maps or reports by other than the signing
party or parties is prohibited without written consent of the
signing party or parties.
7) Contact the appropriate authority prior to any design work on
the herein described parcel for Building and Zoning information.
8) Underground utilities are not depicted hereon, contact the
appropriate authority prior to any design work or construction
on the property herein described. Surveyor shall be notified
as to any deviation from utilities shown hereon.
9) AREA OF PROPERTY: 14,570.00 Sq. Ft. or 0.334 Acres +/-
10) Ownership subject to OPINION OF TITLE.
11) Type of Survey. BOUNDARY SURVEY.
12) North arrow direction shown hereon is based on an assumed meridian:
Along the East line of Lot 1, Block 3, of GOLDEN GATE PARK ADDITION
as shown on Plat Book 6 Page 130.
13) Elevations are based on; National Geodetic Vertical Datum of 1929
14) Miami —Dade Bench Mark Used: L-12 Elev.: 7.04'
15) Bench Mark Location: 200' South and 20' East N.E. corner of Bridge
N.E. 84th Street and N.E. 10th Avenue
16) Property Address: 17) Flood Zone: "X"
910 N.E. 91st Terrace Base Flood Elev.= N/A
Miami Shores, FL FEMA Panel Number;120652-0093—J
Date: July 17, 1995
18) This PLAN OF SURVEY, has been prepared for the exclusive use
of the entities named hereon. The Certificate does not
extended to any unnamed party.
a. TOM & TRACY KNIGHT
b.
19) Field Book: A-236, 16 & 17 W.O. No.:01-108-5401
Data Collector File: N/A
SURVEYOR'S CERTIFICATE:
I Hereby Certify to the best of my knowledge and belief that this
drawing is a true and correct representation of the BOUNDARY SURVEY
of the real property described hereon.
I further certify that this survey was prepared in accordance
with the applicable provisions of Chapter 61G17-6, Florida Administrative
Code.
FORD, ARMF?NTBROS & MANUCY, INC, LB 6557
Original Date Field: November 21, 1995
Revision Date: June 6. 2001 (Uppdate)
Revision Date: December 23. 2002 (Update)
Revision Date: `
BY4co
l _
Radriguez, For i Fir
Professional Surveyor an per, LS 5931